Iatrogenic bile duct injuries: diagnosis and management
DOI:
https://doi.org/10.11606/issn.1679-9836.v102i2e-196909Keywords:
Bile ducts, Cholecystectomy, General surgeryAbstract
Iatrogenic bile duct injury is a serious complication of surgical intervention in the gastrointestinal tract. Even in referral centers, the incidence of such injuries may vary from 0.2% to 1.5%. The incidence varies according to the choice of open surgery or videolaparoscopy and the severity of these injuries derives from the wide range of complications that can be caused, with a strong negative impact on the quality of life of the patient. Iatrogenic bile duct injuries were first classified in 1982 by Bismuth, and, with the advent of videolaparoscopy, various other classification systems were produced, that of Strasberg being one of the most widely used today. Diagnosis can be carried out with the aid of laboratory examinations and, principally, imaging technology, such as magnetic resonance cholangiopancreatography. Treatment presents a serious challenge for the surgeons and can be carried out using percutaneous endoscopic techniques and also surgery, the most common procedure being a Roux-en-Y hepaticojejunostomy. In patients with end-stage liver disease caused by secondary biliary cirrhosis, liver transplantation may be necessary. Whenever possible, the patient should be accompanied by a multidisciplinary team, and it is of paramount importance that such patients should be rapidly referred to a specialist center.
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